What is Cardiac Catheterization in Children?
Cardiac catheterization is a procedure that involves puncturing an artery and / or vein, usually located in the groin, so that a small, long, flexible tube (catheter) can be guided into the heart and major vessels around the heart.
The catheter is moved through the heart with the aid of fluoroscopy (X-ray machine). This is usually performed to help in providing a diagnosis of heart problems.
Interventional catheterization is a type of cardiac catheterization where actual treatments can be performed by use of specialized catheters.
These specialized catheters include balloon catheters that can open up narrowed valves or arteries and also catheters where devices can be deployed which can close extra vessels or certain "holes" in the heart.
Usefulness of Cardiac Catheterization
With cardiac catheterization, pressure measurements and blood samples can be obtained from the various cardiac chambers and blood vessels around the heart allowing calculations of detailed information about the heart's function.
X-ray dye can also be injected through the catheters giving pictures of structures in and around the heart.
Interventional catheterization involves many different therapies for varied heart problems. It is helpful in fixing certain heart problems in children, thereby avoiding an operation.
Some interventions are considered the first choice in treatment and are preferred over surgery. Some interventions are considered palliative, which means they will provide a short-term solution until more definitive surgical repair can be performed more safely.
The types of treatments performed are varied and are individualized to each patient. Most commonly, interventions are used in certain cases where there are narrowed valves or arteries causing obstruction of blood flow.
Interventional catheterization is also performed when there are certain defects in the heart such as extra vessels, or in a patient with an atrial septal defect (hole between the upper two chambers of the heart) to close off these communications.
Day of Procedure
Your child will be admitted to Cincinnati Children's Cardiology Admission & Recovery Unit (CARU), where you will meet the doctors performing the procedure. They will explain the benefits and the risks of the procedure so you will be able to give consent for the procedure.
Your child will need certain tests prior to the procedure including a chest X-ray, an electrocardiogram (EKG), and some blood tests. In some cases, you may also meet with the nurse practitioner the day prior to the procedure where your child will be examined, a nurse will obtain vital signs, and some of this testing may be performed. If not performed then, testing will be performed the morning of the procedure.
Your child may or may not be given some medication to make him / her sleepy in the CARU before being transported to the catheterization laboratory. You will be able to escort your child to the door of the catheterization suite and, from there, you will be directed to the waiting area for the duration of the procedure.
After the catheterization, your child will be taken to the recovery room where he / she will be observed for a couple of hours.
Depending on the type of intervention performed and how well your child recovers, a longer period of observation in the CARU or overnight admission to the cardiac unit may be required.
Questions and Answers
Who Performs the Procedure?
The interventional catheterization is performed only after careful cardiac evaluation by a pediatric cardiologist; therefore, only a pediatric cardiologist can order this procedure.
The request is then reviewed by the cardiologists who specialize in interventional techniques to evaluate the appropriateness of the procedure. Only then will your child be scheduled for the interventional catheterization.
The interventional cardiologist will perform the procedure along with the help of an assistant who is a pediatric cardiology fellow (trainee), nurses and radiology technicians.
Where Is the Cardiac Catheterization Treatment Performed?
The catheterization is performed in the Cardiac Catheterization Suite of the Heart Institute at Cincinnati Children's.
When and How Often Is the Treatment Performed?
The timing of the procedure depends on the type of heart problem your child has. Most procedures need only to be performed once, but some may need a second procedure later in the child's life.
Is Cardiac Catheterization Painful?
A child is given sedation before the procedure. For some procedures, general anesthesia may be recommended.
Generally, the only pain the child may feel is the injection of local anesthetic (similar to novocaine given by the dentist) that is used to numb the area in the groin where the catheters will be inserted.
Intermittent additional sedation is given during the catheterization, as necessary, to keep the child comfortable.
The child may have some bruising in the groin area where the catheters were inserted and may be sore for a couple of days. This generally can be treated with acetaminophen (such as Tylenol).
Is Cardiac Catheterization Risky?
The procedures are generally low risk, with incidence of minor complications under 5 percent. Each type of interventional catheterization procedure has its own unique risks and complications and can be discussed with the doctor performing the catheterization.
What Is the Likelihood of Success?
The likelihood of success of the procedure depends on the type and severity of the heart problem.
Each procedure is individualized to the patient, and its effectiveness can be discussed with your child's cardiologist or one of the specialists in interventional cardiology.